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Case Report Adv Dent & Oral Health Volume 9 Issue 4- July 2018 Copyright © All rights are reserved by Mehmet Özgöz DOI: 10.19080/ADOH.2018.09.555766 Chronic Inflammatory and Treatment: A Case Report

Mehmet Özgöz1* and Taner Arabaci2 1Department of , Akdeniz University, Turkey 2Department of Periodontology, Atatürk University, Turkey Submission: June 14, 2018; Published: July 18, 2018 *Corresponding author: Özgöz, Department of Periodontology, Akdeniz University Faculty of , Antalya, Turkey, Fax:+902423106967; Email:

Abstract Gingival enlargement is a common feature in gingival . If gingival enlargement isn’t treated, it may some aesthetic problems, plaque

accumulation,Keywords: Gingival gingival enlargement; bleeding, and Periodontal periodontitis. treatments; In this paper, Etiological inflammatory factors; Plasma gingival cell enlargement and treatment was presented.

Introduction and retention include poor , abnormal relationship of Gingival enlargement is a common feature in adjacent teeth, lack of tooth function, cervical cavities, improperly contoured dental restorations, food impaction, nasal obstruction, connection with etiological factors and pathological changes [3-5]. [1,2]. Many types of gingival enlargement can be classified in orthodontic therapy involving repositioning of the teeth, and habits such as and pressing the tongue against the gingival [18-20]. a)b) InflammatoryDrug-induced enlargement:enlargement [7-12]. chronic and acute [6]. c) Gingival enlargements associated with systemic : patients to maintain oral hygiene [9,21]. Surgical correction of Overgrowth of the gingival tissue makes it more difficult for i. Conditioned enlargement (, , vitamin the gingival overgrowth is still the most frequent treatment. Such treatment is only advocated when the overgrowth is severe. It enlargement-granuloma pyogenicum). C deficiency, , non-specific conditioned surgery and laser excision [22]. The aim of this paper is to present ii. Systemic diseases causing gingival enlargement ( includes scalpel , overgrowth flap surgery, electro- and granulomatous diseases -Wegener’s granulomatosis, , etc. [13-15]. Casechronic Report inflammatory gingival enlargement and its treatment. d) Neoplastic enlargement (gingival tumors) - benign A 35-year-old female patient came to Atatürk University, tumors and malignant tumors. Department of Periodontology complaining of the gingival enlargement and bleeding.Clinical examination revealed gingival e) False enlargement - these enlargements are not real enlargements but may appear as such because of increase in The enlarged gingiva was edematous and susceptible to bleeding size of the underlying osseous or dental tissue. The gingival enlargement between upper left and right first incisors (Figure 1). when probed. First, intensive control procedures and scaling and root planning was applied. Extirpated tissue tissue usually has no clinical signs of [16,17]. pattern was sent to histological analysis. The histological analysis slight ballooning of the interdental papilla and/or the marginal showed collagen accumulation in the gingival tissue and the Chronic inflammatory gingival enlargement originates as a gingiva. The enlargement is generally papillary or marginal and may be localized or generalized. It progresses slowly and painlessly received oral hygiene advice and was reviewed to check healing. presence of chronic inflammation. After this procedure the patient unless it is complicated by acute or trauma. Chronic One week later, there is no plaque accumulation, but gingival enlargement is continuing. A decision was made to remove the exposure to dental plaque. Factors that favor plaque accumulation gingival enlargement by scalpel gingivectomy. Gingivectomy inflammatory gingival enlargement is caused by prolonged

Adv Dent & Oral Health 9(4): ADOH.MS.ID.555766 (2018) 00109 Advances in Dentistry & Oral Health

procedure was applied to the affected area. The patient was reviewed to check healing. After one week reviewed the operative successfully with local procedures, and fastidious oral hygiene Enlargements resulting from inflammation alone can be treated area irrigated (Figure 2). The patient was reviewed every three prevents recurrence. When systemic or unknown conditions are months for one year. The post-operative follow-up wasn’t eventful. partially, or entirely responsible, surgical removal can eliminate the enlargement. Two techniques are available for this purpose:

technique depends on the size of the enlargement and the gingivectomy and flap operation [18]. Selection of the appropriate character of the tissue. When the enlarged gingiva remains soft and friable even after scaling and root planning, gingivectomy is used

perform the incision and other steps in the technique [18]. In this to remove it, because a flap requires firmer tissue to adequately case we performed gingivectomy technique. Conclusion If we want to treat gingival problems and avoid complications of periodontal therapy, it is necessary to have good knowledge of the cause of enlargement and the underlying pathologic changes and periodontal therapy techniques. References 1. Beyer DJ, Belsito DV (1997) Delayed hypersensitivity to silicon causing gingival . Contact Dermatitis 37(5): 234-235. 2. Figure 1: Appearance of gingival enlargement between upper periodontal diseases. Periodontol 2000 34: 9-21. left and right first incisors. Armitage GC (2004) Periodontal diagnoses and classification of 3. Seymour RA, Ellis JS, Thomason JM (2000) Risk factors for drug- induced gingival overgrowth. J Clin Periodontol27(4): 217-223. 4. Rees TD (1999) Disorders affecting the . Periodontol 2000 21: 145-149. 5. Somacarrera ML, Hernandez G, Acero J, Moskow BS (1994)Factors related to the incidence and severity of cyclosporine-induced gingival overgrowth in transplant patients. A longitudinal study. J Periodontol 65(7): 671-675. 6. Majola MP, McFayden ML, Connolly C, Nair YP, Govender M,et al. (2000)

Periodontol27(7): 506-512. Factors influencing -induced gingival enlargement. J Clin 7. Nishikawa S, Nagata T, Morisaki I, Oka T, Ishida H (1996) Pathogenesis of drug-induced gingival overgrowth. A review of studies in the rat model. J Periodontol 67(5): 463-471. 8. Seymour RA (2006) Effects of medications on the periodontal tissues in health and disease. Periodontol 2000 40: 120-129. 9. Brunet L, Miranda J, Farre M, Berini L, Mendieta C (1996) Gingival enlargement induced by drugs. Drug Saf 15(3): 219-231. 10. Aimetti M, Romano F, Debernardi C (2005) Effectiveness of periodontal therapy on the severity of cyclosporine A-induced gingival over growth. J Clin Peridontol32(8): 846-850. Figure 2: Appearance of affected area after treatment. 11. Embery G, Waddington RJ, Hall RC, Last KS (2000) Connective tissue elements as diagnostic aids in periodontology. Periodontol 2000 Discussion 24(1):193-214. Gingival enlargement is a common feature in gingival disease 12. Rees TD (1998) Drugs and oral disorders. Periodontol 2000 18: 21-36. 13. Buckley DJ, Barrett AP, Bilous AM, Despas PJ (1987) Wegener’s granulomatosis – are gingival changes pathognomonic? J Oral Med42: [1,2]. It can develop from chronic or acute inflammatory changes. complication of other types of enlargement, and together they 169-172. Inflammatory gingival enlargement is usually secondary are called combined gingival enlargement [23]. Treatment of 14. Gonzales TS, Colema GC (1999) Periodontal manifestations of collagen gingival enlargement is based on an understanding of the cause vascular disorders. Periodontol 2000 21: 94-105. of enlargement and the underlying pathologic changes [3-5,18]. 15. Lee W, O’Donnell D (2003) Severe gingival hyperplasia in a child with I-cell disease. Int J Paediatr Dent13(1): 41-45.

How to cite this article: Mehmet Özgöz, Taner Arabaci. Chronic Inflammatory Gingival Enlargement and Treatment: A Case Report. Adv Dent & Oral Health. 00110 2018; 9(4): 555766. DOI: 10.19080/ADOH.2018.09.555766 Advances in Dentistry & Oral Health

16. Wright JM (1999) Reactive, dysplastic and neoplastic conditions of 20. Grant DA, Stern IB, Listgarten MA (1988) Gingival enlargement: periodontal ligament origin. Periodontol 2000 21: 7-15. Lisgarten MA (Eds.),Periodontics in the tradition of Gottlieb and Orban. 17. Khorsandian G, Lapointe HJ, Armstrong JEA, Wysocki GP (2001) Thehyperplastic Mosby Co. and St. inflammatoryLouis, Washington, enlargement. Toronto. In: Grant DA, Stern IB, Idiopathic noncondylarhemimandibular hyperplasia. Int J Paediatr Dent11(4): 298-303. 21. Prisant LM, Herman W (2002) induced gingival overgrowth. J Clin Hypertens 4(4): 310-311. 18. Carranza FA (1996) Gingival enlargement. In:Carranza FA (Ed.), Glickman’s clinical perodontolgy. (8thedn), WB Saunders Co. 22. Mavrogiannis M, Ellis JS, Thomason JM, Seymour RA (2006) Philadelphia, London, Toronto, Montreal, Sydney, Tokyo. The management of drug-induced gingival overgrowth. J Clin Periodontol33(3): 434-439. 19. Fu E, Nieh S, Chang HL, Wang S(1995) Dose-dependent gingival overgrowth induced by cylosporin in rats. J Periodontol 66(7): 594- 23. Kesić L, Mihailović D, Pesić Z, Obradović R (2008) False gingival 598. enlargement as a diagnostic problem: a case report. Int J Dent Hygiene6(1): 68-71.

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How to cite this article: Mehmet Özgöz, Taner Arabaci. Chronic Inflammatory Gingival Enlargement and Treatment: A Case Report. Adv Dent & Oral Health. 00111 2018; 9(4): 555766. DOI: 10.19080/ADOH.2018.09.555766